دورية أكاديمية
Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study.
| العنوان: | Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study. |
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| المؤلفون: | Day J; NIHR Applied Research Collaboration South West Peninsula, Health and Community Sciences, University of Exeter, Exeter, Devon, UK j.k.day@exeter.ac.uk., Simmonds RL; Health and Community Sciences, University of Exeter, Exeter, Devon, UK., Shaw L; Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK., Price CI; Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK., McClelland G; North East Ambulance Service NHS Foundation Trust, Newcastle Upon Tyne, UK.; Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK., Ford GA; Oxford University Hospitals NHS Foundation Trust and Radcliffe Department of Medicine, University of Oxford, Oxford, UK., James M; Royal Devon University Healthcare NHS Foundation Trust and University of Exeter, University of Exeter, Exeter, Devon, UK., White P; Stroke Research Group, Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK., Stein K; NIHR Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, Devon, UK., Pope C; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. |
| المصدر: | Emergency medicine journal : EMJ [Emerg Med J] 2024 Jun 20; Vol. 41 (7), pp. 429-435. Date of Electronic Publication: 2024 Jun 20. |
| نوع المنشور: | Journal Article; Multicenter Study |
| اللغة: | English |
| بيانات الدورية: | Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 100963089 Publication Model: Electronic Cited Medium: Internet ISSN: 1472-0213 (Electronic) Linking ISSN: 14720205 NLM ISO Abbreviation: Emerg Med J Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: London : BMJ Pub. Group, c2001- |
| مواضيع طبية MeSH: | Qualitative Research* , Focus Groups* , Thrombectomy*/methods , Emergency Medical Services*/methods , Stroke*/therapy , Stroke*/surgery, Humans ; England ; Attitude of Health Personnel ; Interviews as Topic ; Male ; Health Personnel ; Female |
| مستخلص: | Background: Mechanical thrombectomy for stroke is highly effective but time-critical. Delays are common because many patients require transfer between local hospitals and regional centres. A two-stage prehospital redirection pathway consisting of a simple ambulance screen followed by regional centre assessment to select patients for direct admission could optimise access. However, implementation might be challenged by the limited number of thrombectomy providers, a lack of prehospital diagnostic tests for selecting patients and whether finite resources can accommodate longer ambulance journeys plus greater central admissions. We undertook a three-phase, multiregional, qualitative study to obtain health professional views on the acceptability and feasibility of a new pathway. Methods: Online focus groups/semistructured interviews were undertaken designed to capture important contextual influences. We purposively sampled NHS staff in four regions of England. Anonymised interview transcripts underwent deductive thematic analysis guided by the NASSS (Non-adoption, Abandonment and Challenges to Scale-up, Spread and Sustainability, Implementation) Implementation Science framework. Results: Twenty-eight staff participated in 4 focus groups, 2 group interviews and 18 individual interviews across 4 Ambulance Trusts, 5 Hospital Trusts and 3 Integrated Stroke Delivery Networks (ISDNs). Five deductive themes were identified: (1) (suspected) stroke as a condition, (2) the pathway change, (3) the value participants placed on the proposed pathway, (4) the possible impact on NHS organisations/adopter systems and (5) the wider healthcare context. Participants perceived suspected stroke as a complex scenario. Most viewed the proposed new thrombectomy pathway as beneficial but potentially challenging to implement. Organisational concerns included staff shortages, increased workflow and bed capacity. Participants also reported wider socioeconomic issues impacting on their services contributing to concerns around the future implementation. Conclusions: Positive views from health professionals were expressed about the concept of a proposed pathway while raising key content and implementation challenges and useful 'real-world' issues for consideration. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.) |
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| فهرسة مساهمة: | Keywords: emergency care systems; pre-hospital care; qualitative research; stroke |
| تواريخ الأحداث: | Date Created: 20240510 Date Completed: 20240620 Latest Revision: 20240827 |
| رمز التحديث: | 20240827 |
| مُعرف محوري في PubMed: | PMC11228204 |
| DOI: | 10.1136/emermed-2023-213350 |
| PMID: | 38729751 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1472-0213 |
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| DOI: | 10.1136/emermed-2023-213350 |